Incentives Help Low-Income Women Stay Smoke-free After Child Birth

Mother and baby

Incentive programs assisting low-income pregnant women with quitting tobacco can be successful, according to a recently published paper in the Journal of Consulting and Clinical Psychology.

UW-CTRI collaborated with the Wisconsin Women’s Health Foundation’s (WWHF) First Breath program to conduct the study of roughly 1,000 pregnant women. The incentive group had a higher abstinence rate at nearly 15 percent 4-6 months after delivery compared to the control group at roughly 9 percent.

This research is important because up to 70 percent of women who quit smoking during pregnancy relapse after delivery, said UW-CTRI Researcher Kate Kobinsky, who co-authored the paper. UW-CTRI Research Director Dr. Tim Baker was the lead author.

The intense program involved First Breath prenatal provider visits, postpartum home visits, and counseling calls with WWHF health educators to help women learn techniques and tackle determinants in their lives to help them quit smoking or stay quit, said Kobinsky.

All study participants received $40 for study enrollment and $40 for each home visit at 1-week and 26-week postpartum visits where they confirmed abstinence with an exhaled CO breath-test. Thus, control group participants could receive up to $120 total.

The incentive group received additional payments for completing up to six prenatal visits at $25 each, up to five postpartum counseling calls at $20 each, and two home visits at $25 each. Therefore, the incentive group participants could earn up to $300 total from the study.

“One of the major difficulties in boosting smoking abstinence in this population is that they’re dealing with so many other life stressors,” said Kobinsky.

In addition to coping with the challenges of a newborn, First Breath participants are faced with major stressors like financial instability, unemployment issues and insecure housing, she said. “For the women, where does this (abstinence) fall in their hierarchy of needs?” Kobinsky said.

Smoking after delivery causes multiple negative health consequences to both the mother and infant, with some of the harms to the infant being lifelong, stated the authors.

The incentives were also successful in getting the women to attend more treatment visits and take more phone calls after childbirth. Furthermore, the women in the incentive group withdrew from the study at a lower rate than control participants.

However, this isn’t the end of research on incentive programs for pregnant smokers, said Kobinsky. “We’d like to see more research done to examine overall cost benefit and effects of varying the size or timing of incentives.”

Baker TB, Fraser DL, Kobinsky K, Adsit R, Smith SS, Khalil L, Alaniz KM, Sullivan TE, Johnson ML, Fiore MC. A Randomized Controlled Trial of Financial Incentives to Low Income Pregnant Women to Engage in Smoking Cessation Treatment: Effects on Post-Birth Abstinence. Journal of Consulting and Clinical Psychology. 2018;86(5):464-73.